VI. OF POISONING WITH OXALIC ACID
The last poison of this order is oxalic acid. It is a substance of very great interest; for it is a poison of great energy, and in this country is in common use for committing suicide, and has been often taken by accident for Epsom salt.
It is certainly ill adapted for the purposes of the murderer; for although it might be easily given to a sick person instead of a laxative salt, yet its real nature would betray itself too soon and too unequivocally for the chief object of the prisoner,—secrecy. Nevertheless, attempts of the kind have been made. At the trial of James Brown for assaulting his wife, held at the Middlesex Autumn Assizes 1827, it was brought out in evidence that he had previously tried to poison her by giving her oxalic acid in gin;[386] and Mr. Alfred Taylor says he is acquainted with two similar cases, where an attempt was made to administer it in tea.[387]
It was first made known as a poison by Mr. Royston in 1814.[388] Its properties have been examined by Dr. A. T. Thomson of London,[389] and Dr. Perey of Lausanne;[390] in 1823, the whole subject of poisoning with oxalic acid in its medico-legal relations was examined by Dr. Coindet of Geneva and myself;[391] and in 1828, another experimental inquiry, which confirms most of the results we obtained, was published by Dr. Pommer of Heilbronn.[392]
SECTION I.—Of the Tests for Oxalic Acid.
Oxalic acid is commonly in small crystals of the form of flattened six-sided striated prisms, transparent, colourless, free of odour, very acid to the taste, and permanent in the air. Two other common vegetable acids, the citric and tartaric acids, present a totally different crystalline form. In general appearance it greatly resembles the sulphate of magnesia, for which it has been so often and so fatally mistaken. So close, indeed, is the resemblance, that repeatedly, on desiring several persons to point out which was the poison and which the laxative, I have found as many fix on the wrong as on the right parcel. The sulphate of magnesia has of course a very different taste, being strongly bitter. Various plans have been devised for preventing the accident to which this unlucky resemblance has given rise. The best of them imply the use of a safeguard by the patient before he takes his laxative draught. It seems to have escaped the notice of those who have proposed the plans in question, that, if accidents are to be prevented in this manner, by far the simplest and most effectual security will be to let the public know, that a laxative salt ought always to be tasted before being swallowed. Its solubility has been much overrated by some chemists. It does not appear to me soluble in less than eleven parts of water.
In determining the medico-legal tests for oxalic acid, it will be sufficient to consider it in two states,—dissolved in water,—and mixed with the contents of the stomach and intestines or vomited matter. If the substance submitted to examination is in the solid state, the first step is to convert it into a solution.
1. In the form of a pure solution, its nature may be satisfactorily determined by the following process.
The acidity of the fluid is first to be established by its effect on litmus-paper.—A small portion is next to be tested with ammonia, which, if the solution of the acid be sufficiently concentrated, will produce a radiated crystallization, as the oxalate of ammonia formed is much less soluble than oxalic acid itself. This property, according to Dr. O’Shaughnessey, distinguishes it from every other acid.[393] The remainder of the fluid is next to be subjected to the following reagents.
Hydrochlorate of lime causes a white precipitate, the oxalate of lime; which is dissolved on the addition of a drop or two of nitric acid,—and is not dissolved when similarly treated with hydrochloric acid, unless the acid is added in very large proportion.
The easy solubility of the oxalate of lime in nitric acid distinguishes the precipitate from the sulphate of lime, which the present test might throw down from solutions of the sulphates, and which is not soluble in a moderate quantity of nitric acid without the aid of heat. The insolubility of the oxalate of lime in hydrochloric acid on the other hand distinguishes the precipitate from the tartrate, citrate, carbonate and phosphate of lime, which the test might throw down from any solution containing a salt of these acids. The last four precipitates are redissolved by a drop or two of hydrochloric acid; but the oxalate is not taken up till a large quantity of that acid is added.
Sulphate of lime in solution causes a white precipitate with oxalic acid, and not with any other.[394]
Sulphate of copper causes a faint bluish-white, or greenish-white precipitate, which is not redissolved on the addition of a few drops of hydrochloric acid. The precipitate is the oxalate of copper. It is redissolved by a large proportion of hydrochloric acid.
This test does not precipitate the sulphates, hydrochlorates, nitrates, tartrates, citrates. But with the carbonates and phosphates it forms precipitates resembling the oxalate of copper. The oxalate, however, is distinguished from the carbonate and phosphate of copper by not being redissolved on the addition of a few drops of hydrochloric acid.
Nitrate of silver causes a dense, white precipitate, the oxalate of silver; which, when collected on a filter, dried and heated, becomes brown on the edge, then fulminates faintly and is dispersed.
The object of the supplementary test of fulmination is to distinguish the oxalate of silver from the numberless other white precipitates which are thrown down by the nitrate of silver from solutions of other salts. The property of fulmination, which is very characteristic, requires, for security’s sake, a word or two of explanation, in consequence of the effect of heat on the tartrate and citrate of silver. The citrate when heated becomes altogether brown, froths up, and then deflagrates, discharging white fumes and leaving an abundant, ash-gray, coarsely fibrous, crumbly residue, which on the farther application of heat becomes pure white, being then pure silver. The tartrate also becomes brown and froths up, but does not even deflagrate, white fumes are discharged, and there is left behind a botryoidal mass, which, like the residue from the citrate, becomes pure silver when heated to redness. Another distinction between the oxalate and tartrate is that the former continues permanent at the temperature of ebullition, while the latter becomes brown. The preceding process or combination of tests will be amply sufficient for proving the presence of oxalic acid, free or combined, in any fluid, which does not contain animal or vegetable principles.
2. The only important modifications in the analysis rendered necessary by the admixture of organic principles, occur in the case of the contents of the alimentary canal or vomited matters.
Dr. Coindet and I proved, that oxalic acid has not any chemical action with any of the common animal principles except gelatin, which it rapidly dissolves;—and that this solution is of a peculiar kind, not being accompanied with any decomposition, either of the acid or of the gelatin.[395] Consequently oxalic acid, so far as concerns the tissues of the stomach or its ordinary contents, is not altered in chemical form, and remains soluble in water.
In such a solution, however, a variety of soluble principles are contained, which would cause abundant precipitates with two of the tests of the process,—sulphate of copper and nitrate of silver; so that the oxalates of these metals could not possibly be detached in their characteristic forms. The process for a pure solution, therefore, is inapplicable to the mixtures under consideration.
But changes of still greater consequence are effected on the poison by exhibiting antidotes during life. It is now generally known, that the proper antidotes for oxalic acid are magnesia and chalk. Each of these forms an insoluble oxalate; so that if either had been given in sufficient quantity, no oxalic acid will remain in solution, and the proofs of the presence of the poison must be sought for in the solid contents of the stomach or solid matter vomited.
The following process for detecting the poison will apply to all the alterations which it may thus have undergone.
Process for Compound Mixtures.—If chalk or magnesia has not been given as an antidote, the suspected mixture is to be macerated if necessary for a few hours in a little distilled water, then filtered, and the filtered fluid neutralized with carbonate of potass. If on the other hand chalk or magnesia has been given, the mixture is to be left at rest for some time, and the supernatant fluid then removed. This fluid, if not acid, may be thrown away; but if acid, it may be treated as already directed for a suspected mixture, where chalk or magnesia has not obtained entrance. After the removal of the supernatant liquid, pick out as many solid fragments of animal or vegetable matter as possible; and add as much pure water to the insoluble residue as will give the mass a sufficiently thin consistence. Add now to the mixture about a twentieth of its weight of carbonate of potass, and boil gently for two hours, or till the organic matter is all dissolved. While dissolution thus takes place, a double interchange is effected between the elements of the carbonate of potass on the one hand, and those of the earthy oxalate on the other, so that an oxalate of potass will at length exist in solution. The fluid when cold is next to be filtered, then rendered very faintly acidulous with nitric acid, then filtered and rendered very faintly alkaline with carbonate of potass, and filtered a third time. At each of these steps some animal matter will be thrown down.
From this point onwards the process proceeds in the same way, whatever may have been the original form in which the acid existed in the mixture; for the oxalate of lime or magnesia in the second case is converted into oxalate of potass.
Add now the solution of acetate of lead to the fluid as long as any precipitate is formed. Collect the precipitate on a filter, wash it well, and dry it by compression between folds of bibulous paper. Remove this precipitate, which consists of oxalate of lead and organic matter in union with oxide of lead, and rub it up very carefully while damp with a little water in a mortar. Transmit sulphuretted hydrogen gas briskly for an hour, so that the whole white precipitate shall be thoroughly blackened; filter and boil. In this manner is formed a sulphuret of lead, which retains a great deal of animal matter; and the oxalic acid being set free, is found in the solution tolerably pure. Filtration before boiling is an essential point in this step, to prevent animal matter being dissolved by the water from the sulphuret of lead. More animal matter may still be separated by evaporating the liquid to dryness at 212°, keeping it at that temperature for a few minutes, and redissolving and filtering. The solution will now exhibit the properties of oxalic acid.
I have found that when this process was applied to a decoction of an ounce of beef in six ounces of water, with which one grain of anhydrous oxalic acid had been mixed, all the tests acted characteristically on the solution ultimately procured. I have farther found, that when two grains of oxalate of lime, which correspond with one grain of oxalic acid, were mixed with a similar decoction in which some fragments of beef were purposely left to complicate the process, a solution was eventually obtained, which gave with muriate of lime a white precipitate insoluble in a little muriatic acid, with sulphate of copper a greenish-white precipitate also insoluble in a little muriatic acid, and with nitrate of silver a white precipitate which fulminated and was almost all dispersed, but left a little charcoal, owing to its containing a small proportion of animal matter. In a case which lately happened in London, every test acted as here described, except that the oxalate of lime did not fulminate, owing to the presence of organic impurities.[396] In order to try the test of fulmination in such circumstances, it is essential to dry the precipitated oxalate of silver thoroughly before raising the temperature to the point at which fulmination usually occurs.
The process now recommended is both delicate and accurate. An objection has been advanced against it,—that acetate of lead will throw down chloride of lead as well as the oxalate of lead; that both will subsequently be decomposed by the sulphuretted-hydrogen? and that the hydrochloric acid thus brought into the solution with the oxalic acid will be precipitated by the nitrate of silver, and form a mixture of salts which will not fulminate characteristically.[397] This objection is not well founded. Chloride of lead being soluble in thirty parts of temperate water, it will seldom be thrown down from such fluids as occur in medico-legal inquiries; and besides it is easily removed, as I have ascertained, by washing the precipitate with moderate care on the filter.
Professor Orfila has advanced another objection,—that the process will yield all the indications mentioned above, if binoxalate of potash be present, or sorrel-soup, which contains a little of that salt.[398] The objection is valid, were these substances apt to come in the way. But the binoxalate of potash is not put to any medicinal use in Britain, and English cookery does not acknowledge the “soupe à l’oseille.” The process he recommends to meet the difficulty, an important one in France, is the following: 1. Having made a watery solution as above, evaporate nearly to dryness, agitate the residue with cold pure alcohol, repeatedly during a period of several hours; decant the tincture, and repeat this step with more alcohol; evaporate to obtain crystals, if possible; dissolve these again in cold pure alcohol, and crystallize a second time by evaporation. If crystals do not form on first concentrating the alcoholic solution, evaporate it till a pellicle begins to form, agitate the residue with cold pure alcohol, and concentrate again to obtain crystals. Lastly, examine the crystals by the tests for pure oxalic acid. The object of these steps in the process is to separate binoxalate of potass, oxalate of magnesia and oxalate of lime, which, he says, are all either not soluble, or very sparingly so, in absolute alcohol. 2. More oxalic acid may be got by acting with distilled water on the matter left by the action of alcohol, evaporating this watery solution nearly to dryness, agitating the residuum with cold alcohol as before, and so on. 3. The preceding operations may have left oxalate of magnesia and oxalate of lime unacted on by the water among the solids remaining on the filter. The former compound may be dissolved out by cold hydrochloric acid diluted with four times its volume of water; and by an excess of pure carbonate of potass, the oxalate of magnesia in the solution is converted into insoluble carbonate of magnesia and soluble oxalate of potass, from which oxalic acid is to be obtained by a salt of lead and sulphuretted-hydrogen, as explained in my own process. 4. Oxalate of lime, which may still remain, is to be sought for by boiling the residuum of the action of hydrochloric acid with solution of bicarbonate of potash, so as to obtain here also an oxalate of potass in solution. I have not had an opportunity of trying this method. But I find, that, contrary to Orfila’s statement, binoxolate of potass, though sparingly soluble in cold alcohol of the density of 800, is sufficiently so to vitiate the principle on which the process is founded.
Caustic potass must not be used for decomposing oxalate of lime or magnesia, because the pure alkali, as Gay-Lussac has shown, produces oxalic acid in acting on animal substances at a boiling temperature. Carbonate of potass has no such effect.
The discovery of oxalic acid in the form of oxalate of lime in the stomach or vomited matter is exposed to a singular fallacy, if a material quantity of rhubarb has been taken recently before death, or before the discharge of the vomited matter. For according to the researches of M. Henry of Paris, rhubarb root always contains some oxalate of lime, and some samples yield so much as 30 and even 33 per cent.[399]
SECTION II.—On the Action of Oxalic Acid and the Symptoms it causes in Man.
The action of oxalic acid on the animal economy is very peculiar.
When injected in a state of concentration into the stomach of a dog or cat, it causes exquisite pain, expressed by cries and struggling. In a few minutes this is succeeded by violent efforts to vomit; then by sudden dulness, languor, and great debility; and death soon takes place without a struggle. The period which elapses before death varies from two to twenty minutes, when the dose is considerable,—half an ounce, for example. After death the stomach is found to contain black extravasated blood, exactly like blood acted on by oxalic acid out of the body; the inner coat of the stomach is of a cherry-red colour, with streaks of black granular warty extravasation; and in some places the surface of the coat is very brittle and the subjacent stratum gelatinized, evidently by the chemical action of the poison.[400] If the stomach is examined immediately after death, little corrosion will be found, compared with what is seen if the inspection be delayed a day or two.[401]
Such are the effects of the concentrated acid. When considerably diluted, the phenomena are totally different. When dissolved in twenty parts of water, oxalic acid, like the mineral acids in the same circumstances, cease to corrode; nay it hardly even irritates. But, unlike them, it continues a deadly poison; for it causes death by acting indirectly on the brain, spine, and heart. The symptoms then induced vary with the dose. When the quantity is large, the most prominent symptoms are those of palsy of the heart; and immediately after death that organ is found to have lost its contractility, and to contain arterial blood in its left cavities. When the dose is less the animal perishes after several fits of violent tetanus, which affects the respiratory muscles of the chest in particular, causing spasmodic fixing of the chest and consequent suffocation. When the dose is still less, the spasms are slight or altogether wanting, and death occurs under symptoms of pure narcotism like those caused by opium: the animal appears to sleep away.
This poison acts with violence, and produces nearly the same effects to whatever texture of the body it is applied. It causes death with great rapidity when injected into the sac of the peritonæum, or into that of the pleura; it acts with still greater quickness when injected into a vein; and it also acts when injected into the cellular tissue beneath the skin, but with much less celerity than through any other channel. Eight grains injected into the jugular vein of a dog occasioned almost immediate death: Thirty-three grains injected into the pleura killed another in twelve minutes. The same quantity did not prove fatal, though it caused violent effects, when retained in the stomach by a ligature on the gullet. One hundred and sixty grains injected under the skin of the thigh and belly did not prove fatal for about ten hours. The symptoms were nearly the same in every case.[402]
It is probable from the facts now stated, that oxalic acid, when not sufficiently concentrated to occasion death by the local injury produced, acts on the nervous system through the medium of the blood. Nevertheless it is a remarkable circumstance that it cannot be detected in that fluid. Mention has already been made of an experiment performed by Dr. Coindet and myself (p. 22), where even after the injection of eight grains of oxalic acid into the femoral vein, and the consequent death of the animal in thirty seconds, none of the poison could be detected in the blood of the iliac vein or vena cava. Similar results have been more lately obtained by Dr. Pommer. In dogs killed by the gradual injection of from five to thirty grains into the femoral vein, he never could detect the poison in the blood of the right side of the heart or great veins, except in the instance of the largest doses, where a little could be detected near the opening in the vein. Dr. Pommer’s experiments likewise agree with those of Dr. Coindet and myself as to the absence of any change in the physical qualities of the blood.[403] When to these circumstances it is added that very small quantities of oxalic acid may be detected in blood, into which it has been introduced immediately after removal from the body by venesection, it appears reasonable to conclude that the poison is quickly decomposed in the blood by vital operations.
According to Orfila, however, it may be detected in the urine, in which crystals of oxalate of lime form on cooling, and more may be obtained on the addition of hydrochlorate of lime. Yet he could not detect any oxalic acid in the liver or spleen.[404]
In man the most prominent symptoms hitherto observed have been those of excessive irritation, because it has been almost always swallowed in a large dose and much concentrated.
It is the most rapid and unerring of all the common poisons. The London Courier contains an inquest on the body of a young man who appears to have survived hardly ten minutes;[405] an equally rapid case of a young lady, who poisoned herself with an ounce, is mentioned in the St. James’s Chronicle;[406] and few of those who have died survived above an hour. This rule, however, is by no means without exception. Mr. Hebb has described a case which did not prove fatal for thirteen hours;[407] Dr. Arrowsmith of Coventry has favoured me with the particulars of a very interesting case which lasted for the same period: and Mr. Frazer has accurately described another, in which, after the patient seemed to be doing tolerably well, an exhausting fever, with dyspepsia and singultus, carried him off in twenty-three days.[408]
Among the fatal cases the smallest dose has been half an ounce; but there can be little doubt that less would be sufficient to cause death. Dr. Babington of Coleraine has published a case where very severe effects were produced by only two scruples.[409]
Very few persons have recovered where the quantity was considerable.
In every instance in which the dose was considerable, and the solution concentrated, the first symptoms have been immediate burning pain in the stomach, and generally also in the throat. But when the dose was small, more particularly if the solution was also rather diluted, the pain has sometimes been slight, or slow in commencing. Mr. Hebb’s patient, who took only half an ounce dissolved in ten parts of water, and diluted it immediately after with copious draughts of water, had not any pain in the belly for six hours.
In general, violent vomiting follows the accession of pain, either immediately, or in a few minutes; and it commonly continues till near death. Some, however, have not vomited at all, even when the acid was strong and in a large dose; and this is still more apt to happen when the poison has been taken much diluted. The man last mentioned did not vomit at all for seven hours, except when emetics were administered. The vomited matter, as in this man’s case, and in that of Mr. Frazer’s patient, is sometimes bloody. Instant discharge of the poison by vomiting does not always save the patient’s life: A woman who swallowed two ounces died in twenty minutes, although she vomited almost immediately after taking the poison.[410]
The tongue and mouth occasionally become inflamed if the case lasts long enough. In an instance of recovery, which happened not long ago in St. Thomas’s Hospital, London, the tongue was red, swollen, tense and tender, the day after the acid was swallowed.[411]
Death commonly takes place so soon, that the bowels are seldom much affected. But when life is prolonged a few hours, they are evidently much irritated. Dr. Arrowsmith’s patient, who lived thirteen hours, had severe pain in the bowels and frequent inclination to go to stool, and Mr. Hebb’s patient, who also lived thirteen hours, had a constant, involuntary discharge of fluid fæces, occasionally mixed with blood. Bloody diarrhœa is very common in dogs.
The signs of depressed circulation are always very striking. In general the pulse fails altogether, it is always very feeble, and the skin is cold and clammy. Contrary to the general fact, however, I once remarked in a dog the pulsation of the heart so strong as to be audible at a distance of several yards.
In some cases nervous symptoms have occurred, but in none so distinctly as in animals that have taken the diluted acid. It should be remarked, however, that few published cases contain good histories of the symptoms; since they commonly come to an end before being seen by the physician. Convulsions appear to have occurred in some instances either at the time of death or soon before it. In the slower cases various nervous affections have been observed. A girl, who swallowed by mistake about two drachms, and did not vomit till emetics were given, complained much at first of pain, but afterwards chiefly of great lassitude and weakness of the limbs, and next morning of numbness and weakness there as well as in the back. This affection was at first so severe that she could hardly walk up stairs; but in a few days she recovered entirely.[412] Analogous effects took place in Mr. Hebb’s patient and in Dr. Arrowsmith’s case. The first thing the former complained of was acute pain in the back, gradually extending down the thighs, occasioning ere long great torture, and continuing almost till the moment of death. Dr. Arrowsmith’s patient had the same symptoms, complained more of the pain shooting down from the loins to the limbs than of the pain in the belly, and was constantly seeking relief in a fresh change of posture. Mr. Frazer’s patient had from an early period a peculiar general numbness, approaching to palsy. Dr. Babington’s patient, who took two scruples by mistake for tartaric acid in an effervescing draught, suffered, after the first twenty-four hours, chiefly from headache, extreme feebleness of the pulse, and a sense of numbness and tingling or pricking in the back and thighs. In a recent case described by Mr. Tapson, which occurred in London, and where it was supposed, but on insufficient grounds,[413] that so much as two ounces had been taken, violent symptoms of irritation in the alimentary canal came on as usual, but soon afterwards a sense as if the hands were dead, loss of consciousness for eight hours, and then lividity, coldness, and almost complete loss of the power of motion in the legs; which symptoms were not entirely removed for fifteen days. In a case related by Mr. Alfred Taylor, where death was caused by seven drachms in fifteen or twenty minutes, there was first violent vomiting, then severe pain in the stomach, and finally clammy perspiration and convulsions, with two or three deep inspirations before death.[414] The effects in this case came very near those generally observed in animals.
In Dr. Arrowsmith’s case two symptoms occurred, which I have not seen mentioned in any other. The first was an eruption or mottled appearance of the skin in circular patches, not unlike the roundish red marks on the arms of stout healthy children, but of a deeper tint. The second was the poisoning and death of leeches applied to the stomach. “They were healthy,” says Dr. Arrowsmith in the notes with which he obligingly furnished me, “small, and fastened immediately. On looking at them in a few minutes I remarked that they did not seem to fill, and on touching one it felt hard and immediately fell off, motionless and dead. The others were all in the same state. They had all bitten and the marks were conspicuous; but they had drawn scarcely any blood. They were applied about six hours after the acid was taken.” This curious fact illustrates the observations formerly quoted from Vernière’s experiments [p. 67]. It will be observed that the leeches were applied several hours after the poison was swallowed, and in a case in which the acid was largely diluted in the stomach;—so that it might have entered the blood and been diffused throughout the body before the observation was made.
SECTION III.—Of the Morbid Appearances caused by Oxalic Acid.
The external appearance of the body is commonly natural. In one instance the cellular tissue was distended with gases ten hours after death.[415] Violent marks of irritation have been commonly found in the stomach; and sometimes that organ has been even perforated.[416] It is probable that the extensive destruction of the coats noticed by some authors has taken place in part after death from the action of the acid on the dead tissues.—The usual conjunction of morbid appearances is well described by Mr. Hebb. The mucous coat of the throat and gullet looked as if it had been scalded, and that of the gullet could be easily scratched off. The stomach contained a pint of thick fluid. This is commonly dark, like coffee-grounds, as it contains a good deal of blood. The inner coat of the stomach was pulpy, in many points black, in others red. The inner membrane of the intestines was similarly but less violently affected. The outer coat of both stomach and intestines was inflamed. The lining membrane of the windpipe was also very red.—The appearances have also been excellently described in the case published by Mr. Alfred Taylor. The inside of the gullet was pale, as if boiled, strongly corrugated and brittle, and covering a ramification of vessels filled with consolidated blood. The stomach presented externally numerous vessels in the same state; and its villous coat was pale, soft, brittle, but here and there injected with vessels. The duodenum and part of the jejunum were red, the other intestines natural, the liver, spleen, and kidneys congested. The stomach contained a brownish jelly, in which gelatin was detected, as well as oxalic acid. The blood was fluid every where except in the vessels of the gullet and stomach.[417] The consolidated condition of the blood there was evidently owing to the local action of a strong acid, and is the same with what has been observed in poisoning with the mineral acids.—In Mr. Frazer’s patient the whole villous coat of the stomach was either softened or removed, as well as the inner membrane of the gullet, so that the muscular coat was exposed; and this coat presented a dark gangrenous-like appearance, being much thickened and highly injected.
Although these signs of violent irritation are commonly present, it must at the same time be observed, that some cases have occurred where the stomach and intestines were quite healthy. In a girl who died about thirty minutes after swallowing an ounce of the acid, no morbid appearance whatsoever was to be seen in any part of the alimentary canal.[418] In the case of a girl, described by Mr. Anderson, where death took place in twenty minutes, there was no appearance but contraction of the rugæ of the gullet and stomach, one spot of extravasation in the latter and doubtful softening of its villous coat.[419]
The state of the other organs of the body has not been taken notice of in published cases. In several instances, as in Mr. Taylor’s case, the blood in the veins of the stomach is described as having been black and as it were charred; probably by the chemical action of the acid after death.
SECTION IV.—Of the Treatment of Poisoning with Oxalic Acid.
The chief part of the treatment of this kind of poisoning is obvious. On account of its dreadful rapidity, remedies cannot be of material use unless they are resorted to immediately after the acid has been swallowed. Emetics may be given, if vomiting is not already free; but time should never be lost in administering them if an antidote is at hand. In particular it is necessary to avoid giving warm water with a view to accelerate vomiting, unless it is given very largely; for moderate dilution will promote the entrance of the poison into the blood, if it has not the effect of immediately expelling it.
The principal object of the practitioner should be to administer as speedily as possible large doses of magnesia or chalk suspended in water. Chalk has been given with great advantage in several cases,[420] and magnesia has also been of service.[421] As no time should be lost, the plaster of the apartment may be resorted to, when chalk or magnesia is not at hand. These substances not only neutralize the acid so as to take away its corrosive power, but likewise render it insoluble, so as to prevent it from entering the blood. There appears no particular reason for using the stomach-pump when antidotes are at hand. But fashion seems to have authorised the employment of this instrument for every kind of poison.[422] Alkalis are inadmissible. As might be inferred from the general statements formerly made on the effect of chemical changes on poisons [p. 28], the alkalis, as they form only soluble salts, will not deprive oxalic acid of its remote or indirect action; and instances are not wanting of their inutility in actual practice.
Oxalic acid is one of the poisons alluded to under the head of General Poisoning,—of whose operation distinct evidence may sometimes (though certainly not always) be found in the symptoms. If a person, immediately after swallowing a solution of a crystalline salt, which tasted purely and strongly acid, is attacked with burning in the throat, then with burning in the stomach, vomiting particularly of bloody matter, imperceptible pulse and excessive languor, and dies in half an hour, or still more in twenty, fifteen, or ten minutes, I do not know any fallacy which can interfere with the conclusion, that oxalic acid was the cause of death. No parallel disease begins so abruptly and terminates so soon; and no other crystalline poison has the same effects.
Poisoning with the Oxalates.—Oxalic acid is one of the best examples of a poison that acts through all its soluble chemical combinations. Dr. Coindet and I found that the oxalates of potash and ammonia are little inferior in energy to the acid. They do not corrode, indeed, and scarcely ever irritate; but they produce tetanus and coma, like the diluted acid. Half a drachm of oxalic acid neutralized with potass will kill a rabbit in seventeen minutes; ninety grains of neutral oxalate of ammonia will kill a strong cat in nine minutes.[423] The binoxalate of potash, the most familiar of the salts of oxalic acid, was not tried by us. But the preceding facts would leave little doubt of its being a poison.
Since the last edition of this work was published several cases have occurred which amply confirm the results of experimental inquiry. In Dr. Babington’s case alluded to above, the greater part of the oxalic acid had been neutralized by bicarbonate of soda [p. 176].—Mr. Tripier has communicated the particulars of a case in which half an ounce of the binoxalate of potash was taken by mistake for bitartrate of potash in hot water, and caused death in eight minutes, after an attack of violent pain and convulsions.[424]—A young woman at Bordeaux was attacked with frequent vomiting after a dose of a drachm and a half of the same salt dissolved in a ptisane. Next morning a similar dose caused bloody vomiting and acute pain at the pit of the stomach; and a third dose the following day excited delirium, more violent vomiting, and death in the course of an hour.[425]—A girl in London swallowed about an ounce of the same salt dissolved in hot water. Sickness and faintness ensued, with imperceptible pulse, cold, clammy skin, rigors, scalding of the mouth and throat, pain in the back, soreness of the eyes, redness of the conjunctivæ, and dilatation of the pupils. Afterwards there was reaction, with a full frequent pulse, hot skin, flushed countenance, headache, thirst, and tenderness of the abdomen. She recovered under the use of chalk, external heat, ether and opium draughts, leeches and sinapisms to the belly, and carbonate of ammonia.[426]
No account has yet been published of the morbid appearances in man.
The proper antidote is sulphate of magnesia. Failing this, weak milk of lime may be given with advantage.
Appendix on Tartaric and Citric Acid.—These two acids may be taken in considerable quantities without injury. Dr. Coindet and I gave a drachm of each in solution to cats, without observing that the animals suffered any inconvenience.[427] Dr. Sibbald, a surgeon of this place, has informed me of an instance in which a patient of his took in twenty-four hours six drachms of tartaric acid, having by mistake omitted the carbonate of potass sent along with the acid to make effervescing draughts; and yet he did not suffer any more inconvenience then the cats on which Dr. Coindet and I experimented.
Pommer, however, found that tartaric acid is scarcely less active than oxalic acid when injected into the blood. When fifteen grains dissolved in half an ounce of water were injected into the femoral vein of a dog in four doses, difficult breathing and discharge of fæces and urine were produced after each operation, and death speedily ensued without any other particular symptom. As in the instance of oxalic acid, the blood in the great veins was not apparently changed in any of its physical qualities. The heart continued contractile long after death, while in the case of oxalic acid its contractility was suddenly extinguished.[428]
VII. OF THE ALKALIS AND ALKALINE SALTS
The second order of the class of irritants comprehends the alkalis, some of the alkaline salts, and lime. The species which it includes are little allied to one another except in chemical composition; and in particular they are little allied in physiological properties. It appears impossible, however, to make a better arrangement than that proposed by Orfila, which will therefore be here followed.
Most of the poisons of the second order are powerful local irritants. Some of them likewise act indirectly on distant organs; and a few are more distinguished by their remote than by their local effects. This order may be conveniently divided into two groups,—the one embracing the two fixed alkalis with their carbonates, nitrates, and chlorides, and also lime,—the other ammonia, with its salts, and likewise the alkaline sulphurets.
The action of the first group is purely irritant and strictly local. When concentrated, the fixed alkalis and their carbonates produce chemical decomposition, softening the animal tissues, and reducing them eventually to a pulpy mass; which change depends on their possessing the power, as chemical agents, of dissolving almost all the soft solids of the body. When much diluted, they produce inflammation, without corroding the textures; and it does not appear that they are even then absorbed in such quantity as to prove injurious to any remote organ. The action of the alkaline nitrates and of lime is that of irritants only; at least their chemical action is obscure and feeble.
Of the Fixed Alkalis and their Carbonates.
Section I.—Of their Tests.
Potass in its caustic state, as usually met with in the shops, forms little gray-coloured cylinders or cakes which have a radiated, crystalline fracture, and an excessively acrid caustic taste, and feel soapy if touched with the wet finger. It deliquesces rapidly in moist air, and then attracts carbonic acid from the atmosphere. It is easily fused by heat, and is exceedingly soluble in water. The solution has a strong alkaline reaction on vegetable colours, restoring reddened litmus to blue, turning syrup of violets or infusion or red cabbage to green, and rendering infusion of turmeric brown. It is distinguished from the alkaline earths when in solution, by not precipitating with carbonic or sulphuric acid, and from soda by the tests to be presently mentioned for its carbonate.
Carbonate of potash [subcarbonate, salt of tartar], is usually sold, when pure, in small white grains, formed by melting the salt and stirring it rapidly as it cools. In its impure state it is called in this country potashes, and when somewhat purified, pearl ash. It has then a mixed grayish, yellowish, or bluish colour, and is sold in crumbly lumps of various sizes. In every state it is deliquescent and very caustic. It cannot be crystallized. It gives out carbonic acid gas with the addition of any stronger acid, such as sulphuric, muriatic, or acetic acid. Its solution precipitates yellow with the chloride of platinum, gives a crystalline precipitate with perchloric acid, when the salt forms not less than a fortieth or fiftieth part,—is similarly acted on by a considerable excess of tartaric acid, if the salt constitute about a thirtieth of the fluid,—and yields with the soluble salts of baryta a white precipitate soluble in nitric acid.
Soda resembles potass closely in chemical as well as physiological properties; and the carbonate bears the same resemblance to the carbonate of potass. The chief differences are the following. The carbonate of soda is easily crystallized, and effloresces on exposure to the air. A solution in twenty parts of water yields no precipitate with either perchloric acid or an excess of tartaric acid, because there is no sparingly soluble perchlorate or bitartrate, as in the case of potash. Its solution is precipitated by antimoniate of potash, because the antimoniate of soda is very sparingly soluble. All its salts remain unaffected by the chloride of platinum, because their base cannot form like potass an insoluble triple salt with the reagent. The acetate of soda is permanent in the air, while the acetate of potass is one of the most deliquescent salts known. In trying this last test, which is very characteristic, care must be taken to avoid an excess of acid in the acetate of soda by expelling it at a temperature of 212°, otherwise the salt is as deliquescent as the acetate of potass.—Another difference is, that the chloride of sodium, being nearly as soluble in temperate as in boiling water, crystallizes with difficulty and but sparingly by cooling a concentrated boiling solution; while the chloride of potassium is much more soluble in hot than in cold water, and crystallizes easily and abundantly when a concentrated boiling solution is cooled down.
Process for Potash and its Carbonate in Organic Mixtures.—The following method has been lately recommended for the detection of potash and its carbonate in complex organic mixtures. Ascertain that the mixture is alkaline in its action on litmus-paper and turmeric-paper, and that it is not ammoniacal in odour. Distil to one-third; ascertain that it has still an alkaline reaction, and evaporate to dryness in a porcelain basin. Agitate the residue, when cold, with absolute alcohol; boil, pour off the liquor, and filter it while hot. Repeat this with the residuum and more alcohol. Distil off most of the alcohol, and evaporate to dryness. Raise the heat to char the residuum, continue the heat as long as vapours come off, remove the charcoaly matter, and incinerate it for forty-five minutes in a silver crucible. Try to separate potash from what remains by means of absolute alcohol; and if this do not succeed, remove carbonate of potash by boiling water. In either case search for potash by litmus-paper, turmeric-paper, chloride of platinum, and perchloric acid.[429]
The conclusiveness of this process depends upon the fact, that absolute alcohol cannot dissolve from solid organic substances such a proportion of lactate, tartrate, acetate, sulphate, or phosphate of potash, or chloride of potassium, as to be acted on by chloride of platinum or perchloric acid.[430]—It is to be observed that carbonate of potash singly is insoluble in absolute alcohol; but it becomes soluble in that fluid, when it is conjoined with various organic matters. Hence it is that this process, intended fundamentally for caustic potash alone, is applicable to carbonate of potash also.
Process for Soda and its Carbonate in Organic Mixtures.—These substances may be separated by the method just described for potash. If the alcoholic solution of the extract of the suspected matter be alkaline in its action on litmus, and be afterwards found to contain soda or its carbonate, the evidence of these substances having been derived from without is satisfactory, because the carbonate of soda contained in many animal matters cannot be so detached. But if no indications of the presence of soda be thus obtained, it is not enough that soda be found in the alcoholic solution of the incinerated alcoholic extract, because the natural carbonate of soda of animal matter may be separated in that manner.[431]
SECTION II.—Of the Action of the fixed Alkalis, and the Symptoms they cause in Man.
The action of the two fixed alkalis and their carbonates on the animal system is so nearly the same, that the facts which have been ascertained in respect to one of them will apply to all the rest. The operation of potass and its carbonate has been carefully investigated by Professor Orfila,[432] and by M. Bretonneau of Tours.[433]
When caustic potass is injected in minute portions into the veins, it instantly coagulates the blood. Five grains, according to Orfila, will in this way kill a dog in two minutes. But when small doses either of potash itself, or its carbonate, or indeed any of its salts are used, Mr. Blake found, that without coagulating the blood, they arrested the action of the heart in ten seconds, if injected into the jugular vein; and that when they were injected into the carotid artery, they occasioned in four seconds signs of great obstruction in the capillary circulation, and arrestment of the heart’s action in thirty-five minutes, through means of this effect. Next to the salts of baryta he thought the potash salts the most powerful on the heart’s action of all those he tried.[434] When introduced into the stomach potash acts powerfully as an irritant, and generally corrodes the coats of that organ. Thirty-two grains given by Orfila to a dog caused pain in the gullet, violent vomiting, much anguish, restlessness, and death on the third day. On dissection he found the inner coat of the gullet and stomach black and red; and near the pylorus there was a perforation three-quarters of an inch wide, and surrounded by a hard, elevated margin. The observations of Bretonneau are in some respects different. When potass was swallowed by dogs in the dose of 40 grains, he found that the animals, after suffering for some time from violent vomiting, always died sooner or later of wasting and exhaustion; and that the action of the poison was confined chiefly to the gullet, which was extensively destroyed and ulcerated on its inner surface. But when the gullet was defended by the potass being passed at once into the stomach in a caustic holder, larger doses, even several times repeated, did not prove fatal. The usual violent symptoms of irritation prevailed for two or three days; but on these subsiding, the animals rapidly recovered their appetite and playfulness, appearing in fact to be restored to perfect health. Yet there could be no doubt that the stomach all the while was severely injured; for in some of the animals, which were strangled for the sake of examination several weeks after they took the poison, the villous coat was found extensively removed, and even the muscular and peritonæal coats were here and there destroyed and cicatrized. Bretonneau farther adds, that ten or fifteen grains introduced into the rectum caused death sooner than three times as much given by the mouth.
The carbonate of potass possesses properties similar in kind, but inferior in degree to those of the caustic alkali. Two drachms given by Orfila to a dog killed it in twenty-five minutes, violent vomiting and great agony having preceded death. The stomach was universally of a deep-red colour on its inner surface.
Potash and its carbonate are absorbed in the course of their action, and may be detected by Orfila’s process in the liver, kidneys, and urine.[435]
The actions of soda and its carbonate seem on the whole the same with those of potash; but they are not so energetic. In one respect however soda and its salts differ most materially from those of potash. For while the latter, when admitted directly into a vein, act by arresting the action of the heart, soda and its salts, according to the inquiries of Mr. Blake, have no such effect, but cause death by obstructing the circulation of the pulmonary capillaries, and preventing the return of blood from the lungs to the left side of the heart. This conclusion seems to flow from the following facts. The respiration becomes in a few seconds laborious and soon ceases, whilst the heart continues to beat vigorously: arterial pressure is greatly reduced, while venous pressure is much increased owing to accumulation of blood in the right side of the heart: after death the lungs are found congested and often full of froth: and the heart continues contractile, very turgid in the right side, but quite empty of blood in its left cavities.[436]
Poisoning with the caustic alkalis is rare. In 1842, a lady suffering from inflammation of the bowels took an ounce of solution of potass by mistake for kali-water, or a solution of bicarbonate of potash surcharged with carbonic acid. She suffered severely at the time, and died in a fortnight, probably of the conjunct effects of her disease and the poison.[437] This is the only case I have found in print of poisoning with a caustic alkali. But the effects of their carbonates have been several times witnessed, and appear to resemble closely those of the concentrated mineral acids.
The symptoms are in the first instance an acrid burning taste, and rapid destruction of the lining membrane of the mouth; then burning and often constriction in the throat and gullet, with difficult and painful deglutition; violent vomiting, often sanguinolent, and tinging vegetable blues green; next acute pain in the stomach and tenderness of the whole belly; subsequently cold sweats, excessive weakness, hiccup, tremors and twitches of the extremities; and ere long violent colic pains, with purging of bloody stools and dark membranous flakes. So far the symptoms are nearly the same in all cases; but in their subsequent course several varieties may be noticed.
In the worst form of poisoning death ensues at an early period, for example within twenty-four hours, nay even before time enough has elapsed for diarrhœa to begin. A case of this kind, which has been very well described by Mr. Dewar of Dunfermline, and which arose from the patient, a boy, having accidentally swallowed about three ounces of a strong solution of carbonate of potass, proved fatal in twelve hours only.[438] Here death was owing to the general system or some vital organ being affected through sympathy by the injury sustained by the alimentary canal.
In the mildest form, as in a case related by Plenck[439] of a man who swallowed an ounce of the carbonate of potass, the symptoms represent pretty nearly an attack of acute gastritis when followed by recovery,—the effects on man being then analogous to those observed by Bretonneau in animals, when the poison was introduced into the stomach without touching the gullet.
But a more common form than either of the preceding is one, similar to the chronic form of poisoning with the mineral acids, in which constant vomiting of food and drink, incessant discharge of fluid, sanguinolent stools, difficulty of swallowing, burning pain from the mouth to the anus, and rapid emaciation, continue for weeks or even months before the patient’s strength is exhausted; and where death is evidently owing to starvation, the alimentary canal being no longer capable of assimilating food. Two characteristic examples of this singular affection have been recorded in the Medical Repository,[440] and a third, of which the event has not been mentioned, but which would in all likelihood end fatally, has been communicated by M. Jules Cloquet to Orfila.[441] Of the two first cases, which were caused by half an ounce of carbonate of potass having been taken in solution by mistake for a laxative salt, one proved fatal in little more than a month, the other three weeks afterwards. In Cloquet’s case, at the end of the sixth week the membrane of the mouth was regenerated; but the gullet continued to discharge pus, and the stools were purulent and bloody.
Another form perhaps equally common with that just described, and not less certainly fatal, commences like the rest with violent symptoms of irritation in the mouth, gullet, and stomach; but the bowels are not affected, and by and by it becomes apparent that the stomach is little injured; dysphagia or even complete inability to swallow, burning pain and constriction in the gullet, hawking and coughing of tough, leathery flakes, are then the leading symptoms; at length the case becomes one of stricture of the œsophagus with or without ulceration; the bougie gives only temporary relief, and the patient eventually expires either of mere starvation, or of that combined with an exhausting fever. Mr. Dewar has related a very striking example of this form of poisoning with the alkalis.[442] His patient, after the first violent symptoms had exhausted themselves, which took place in sixteen or eighteen hours, suffered little for four or five days till the sloughs began to separate from the lining membrane of the mouth, throat, and gullet. The affection of the gullet then became gradually predominant, and terminated in stricture, of which she appears to have been several times so much relieved as to have been thought in a fair way of recovery. After repeatedly disappointing Mr. Dewar’s hopes of a successful issue by her intemperance in the use of spirituous liquors, she died of starvation about four months after swallowing the poison. Sir Charles Bell has noticed three parallel cases, and has given delineations of the appearance in the gullet of two of them.[443] One of his patients did not die till twenty years after swallowing the poison, which in this instance was soap-less; yet he does not hesitate to ascribe the stricture to that cause, and says death arose purely from starvation.
The carbonate of soda, though a salt in very common use, has not hitherto been the cause of accident, which has found its way into print. It is plainly much less actively corrosive than carbonate of potass, and is therefore probably in every sense less energetic.
SECTION III.—Of the Morbid Appearances caused by the fixed Alkalis.
The morbid appearances caused by potass, soda, and their carbonates differ with the nature of the case.
In the boy who died in twelve hours Mr. Dewar found the inner membrane of the throat and gullet almost entirely disorganized and reduced to a pulp, with blood extravasated between it and the muscular coat. The inner coat of the stomach was red, in two round patches destroyed, and the patches covered with a clot of blood;—its outer coat, as well as all the other abdominal viscera, was sound.
In the two chronic cases mentioned in the Medical Repository the mischief was much more general, the whole peritonæum being condensed, the omentum dark and turgid, the intestines glued together by lymph, the external coats of the stomach thick, the villous coat almost all destroyed, what remained of it red and near the pylorus ulcerated, and the pyloric orifice of the stomach plugged up with lymph so as barely to admit a small probe.
In Mr. Dewar’s patient who died of stricture of the gullet the intestines were sound, the inner surface of the stomach red especially towards the cardia, the inner and muscular coats of the gullet thickened and firmly incorporated together by effused lymph, the inner coat here and there wanting, the passage of the gullet every where contracted, and to such a degree about two inches above the cardia as hardly to pass a common probe. In Sir C. Bell’s cases the appearances were similar.
Orfila says he is led to conclude from a great number of facts that of all corrosive poisons potass is the one which most frequently perforates the stomach.[444] This appearance, however, has not been mentioned in any case of poisoning in the human subject.
SECTION IV.—Of the Treatment of Poisoning with the fixed Alkalis.
In the treatment of poisoning with the alkalis the first object is evidently to neutralize the poison. This may be done either with a weak acid, or with oil. Of the acids the acetic in the form of vinegar is most generally recommended, as it is not itself injurious. A successful case in very unpromising circumstances, where two ounces and a half of carbonate of potash had been taken by mistake for cream of tartar, and where the antidote was not administered for half an hour, has been related by M. Liégard of Caen. Great relief was experienced to the burning in the throat and stomach, the chilliness, difficult breathing, and frequent efforts to vomit, which were the first symptoms; and after repeated alternations of collapse and reaction, convalescence was established in eight days.[445]—M. Chereau thinks that for the mineral alkalis and their carbonates fixed oil is a preferable antidote to vinegar; and he has given the heads of two cases of poisoning with large doses of carbonate of potass, in which the free employment of almond oil prevented the usual fatal consequences. It appears to act partly by rendering the vomiting free and easy, partly by converting the alkali into a soap. It must be given in large quantity, several pounds being commonly required.[446] For the subsequent treatment the reader may consult the paper of Mr. Dewar, which contains many useful hints on the management of the most complex description of cases.
VIII. OF POISONING WITH NITRATE OF POTASS
The nitrate of potass [nitre, saltpetre, sal-prunelle], is a dangerous poison. It has been often mistaken for the saline laxatives, especially the sulphate of soda, and has thus been the source of fatal accidents.
SECTION I.—Of the Chemical Tests for Nitrate of Potass.
It exists in commerce and the arts in two forms, fused and crystallized. The fused nitre [sal-prunelle] is sold in little button-shaped masses, spheres of the size of musket-balls, or larger circular cakes, of a snow-white tint. The crystallized salt [sal-petre] is sold in whitish, sulcated crystals, which are often regular and large. They are six-sided prisms, more or lest flattened, and terminated by two converging planes. In both forms nitre has a peculiar, cool, but sharp taste.
Its chemical properties are characteristic. In the solid form, it animates the combustion of burning fuel, and yields nitrous fumes when heated with strong sulphuric acid. In solution it is precipitated yellow by the chloride of platinum, and yields, when not greatly diluted, a crystalline precipitate with perchloric acid. The crude salt of commerce contains chloride of sodium; and hence the odour disengaged by sulphuric acid may be mixed with that of chlorine or hydrochloric acid gas. When mixed with any vegetable or animal infusion by which it is coloured, crystals may sometimes be easily procured in a state of sufficient purity by filtration and evaporation. But if not, then the same process must be resorted to with that formerly recommended for nitric acid (p. 143), the first step of neutralization with potass being of course dispensed with.—A process nearly the same with this has been suggested by M. Kramer of Milan. He proposes to free the liquid in part of animal matter by adding acetate of lead, transmitting sulphuretted-hydrogen through the filtered fluid to remove any excess of lead, boiling the fluid after another filtration, and then proceeding with acetate of silver to remove chlorides, as in the process I have adopted. In this way he found nitre even in the blood.[447]
SECTION II.—Of the Action of Nitrate of Potass and its Symptoms in Man.
This substance forms an exception to the general law formerly laid down with regard to the effect of chemical neutralization on the local irritants. Both its acid and its alkali are simple irritants; yet the compound salt, though certainly much inferior in power, is still energetic. Nay, the experiment of Orfila and the particulars of some recently published cases tend even to prove, that the action of its alkali and acid is materially altered in kind by their combination with one another; for, besides inflaming the part to which it is applied, nitre has at times produced symptoms of a secondary disorder of the brain and nerves.
The experiments of Orfila upon dogs show that on these animals it has a twofold action, the one irritating, the other narcotic. He found that an ounce and a half killed a dog in ninety minutes when the gullet was tied, and a drachm another in twenty-nine hours: that death was preceded by giddiness, slight convulsions, dilated pupil, insensibility and palsy; that after death the stomach was externally livid, internally reddish-black, and the heart filled in its left cavities with florid blood; that when the gullet was not tied the animals recovered after several attacks of vomiting, and general indisposition for twenty-four hours; and that when the salt was applied externally to a wound it excited violent inflammation, passing on to gangrene, but without any symptom which indicated a remote or indirect operation.[448] Mr. Blake found that this salt, when injected into the veins of a dog in the dose of fifteen grains dissolved in twenty-four parts of water, causes sudden depression and arrestment of the action of the heart, and death in less than a minute; but that, like other salts of potash, it has no influence on the capillaries of the lungs, though a powerful effect in obstructing the systemic capillary system.[449]—When taken in the ordinary way, it is absorbed in the course of its action, and has been detected both in the blood and the urine by Kramer of Milan.[450]
As to its effects on man, it must first be observed, that considerable doses are necessary to cause serious mischief. In the quantity of one, two, or three scruples, it is given medicinally several times a day without injury; and Dr. Alexander found by experiments on himself, that an ounce and a half, if largely diluted, might thus be safely administered in the course of twenty-four hours.[451] Sometimes, too, even large single doses have been swallowed with impunity. A gentleman of my acquaintance once took nearly an ounce by mistake for Glauber’s salt, and retained it above a quarter of an hour: nevertheless, except several attacks of vomiting, no unpleasant symptom was induced. M. Tourtelle has even related an instance where two ounces were retained altogether and caused only moderate griping, with considerable purging and flow of urine.[452] Resting on such facts as these Tourtelle, with some physicians in more recent times,[453] has maintained that nitre is not a worse poison than other saline laxatives; and some practitioners of the present day have consequently ventured to administer it for the cure of diseases, in the quantity of half an ounce in one dose.[454] It is not easy to say, why these large doses are at times borne by the stomach without injury,—whether the cause is idiosyncrasy, or a constitutional insensibility engendered by disease, or some difference in the mode of administering the salt. But at all events, the facts which follow will leave no doubt that in general it is a dangerous and rapid poison in the dose of an ounce.
Dr. Alexander found that, in the quantity of a drachm or a drachm and a half, recently dissolved in four ounces of water, and repeated every ninety minutes, the third or fourth dose caused chilliness and stinging pains in the stomach and over the whole body; and these sensations became so severe with the fourth dose, that he considered it unsafe to attempt a fifth.[455]
Two cases which were actually fatal have been described in the Journal de Médecine for 1787, the one caused by one ounce, the other by an ounce and a half. In the latter the symptoms were those of the most violent cholera, and the patient died in two days and a half;[456] in the former death took place in three hours only, and in addition to the symptoms remarked in the other there were convulsions and twisting of the mouth.[457] In both the pulse failed at the wrist, and a great tendency to fainting prevailed for some time before death. Dr. Geoghegan has communicated to Mr. Taylor a case where an ounce and a half taken by mistake caused severe pain in the stomach, vomiting, and death in two hours.[458]
Similar effects have been remarked in several cases which have been followed by recovery. A woman in the second month of pregnancy, immediately after taking a handful of nitre in solution, was attacked with pain in the stomach, swelling of the whole body and general pains; she then miscarried, and afterwards had the usual symptoms of gastritis and dysentery, united with great giddiness, ringing in the ears, general tremors and excessive chilliness. She seems to have made a narrow escape, as for three days the discharges by stool were profuse, and composed chiefly of blood and membranous flakes.[459] Dr. Falconer has related another instance, where also the patient’s life seems to have been in great danger. The quantity taken was two ounces, and it was swallowed in half a pint of warm water by mistake instead of a laxative salt. Violent pain in the belly was immediately produced, in half an hour frequent vomiting, and in three hours a discharge of about a quart of blood from the stomach. After the administration of gruel and butter the symptoms began to subside; but they receded slowly; and even six months afterwards the man, though otherwise in good health, had frequent pain in the stomach and flatulence.[460] In the case of a female in the second month of pregnancy, described by Dr. Butter, miscarriage did not take place, although the symptoms were very violent and lasting. The quantity taken was two ounces. The symptoms were first bloody vomiting, afterwards dysentery, which continued seven days; and on the tenth day a nervous affection supervened exactly like chorea, and of two months’ duration.[461] The effects of the poison in the latter period of this woman’s illness tend to establish the existence of a secondary operation on the nervous system. But this kind of action is more strongly pointed out by the following cases. Three puerperal women in the Obstetric Hospital of Pavia got each an ounce of nitre by mistake for sulphate of magnesia. Two, who vomited immediately, did not suffer. The third, who retained the salt fifteen minutes, had pain in the stomach and vomiting, followed by paleness of the countenance, stiffness of the jaw, some stupor, and convulsive movements of the limbs; which symptoms continued till next day, when she gradually recovered.[462] A German physician, Dr. Geiseler, met with an instance, in which the only disorder produced appeared to depend on derangement of the cerebral functions. A woman, after swallowing an ounce of nitre instead of Glauber’s salt, lost the use of speech and the power of voluntary motion, then became insensible, and was attacked with tetanic spasms. This state lasted till next day, when some amelioration was brought about by copious sweating. It was not, however, till eight days after, that she recovered her speech, or the entire use of her mental faculties; and the palsy of the limbs continued two months.[463] Her case resembles the account given by Orfila of the effects of nitre on animals.
SECTION III.—Of the Morbid Appearances caused by Nitrate of Potass.
The morbid appearances observed in man are solely those of violent inflammation of the stomach and intestines. In Laflize’s case, which proved fatal in three hours, the stomach was distended, and the contents deeply tinged with blood; its peritonæal coat of a dark-red colour mottled with black spots; its villous coat very much inflamed and detached in several places. The liquid contents gave satisfactory evidence of nitre having been swallowed; for a portion evaporated to dryness deflagrated with burning charcoal. In Souville’s patient, who lived sixty hours, the stomach was every where red, in many places checkered with black spots, and at the centre of one of these spots the stomach was perforated by a small aperture. The whole intestinal canal was also red. In Dr. Geoghegan’s case, the stomach contained bloody mucus, and its villous coat was brownish-red, and here and there detached. He could not detect any nitre in it.
IX. OF POISONING WITH THE ALKALINE AND EARTHY CHLORIDES
There can be little doubt that the chlorides of soda, potass, and lime are active poisons; but the first two have alone been hitherto carefully investigated by physiological experiments.
The two alkaline chlorides are usually seen in the form of colourless solutions. That of potass is little known in this country; but that of soda is familiar to all in the shape of Fincham’s chloride of soda or bleaching liquid. The chloride of lime, which is best known of them all, is usually in the form of a dry powder, deliquescent, and acrid, commonly termed bleaching powder. All these substances are easily known by their peculiar odour of chlorine, and the copious disengagement of that gas on the addition of sulphuric acid.
The action of chloride of soda on the animal body has been examined by Segalas, who infers that it is an irritant poison, which, however, at times occasions symptoms of an affection of the nervous system. He remarked that three ounces of the solution, commonly sold in Paris under the name of Labarraque’s disinfecting liquid, caused immediate death by coagulating the blood in the heart, when injected into a vein in a dog. Two ounces introduced into the peritonæum excited palpitation, oppressed breathing, constant restlessness, and death in ten minutes; and three drachms did not prove fatal for some hours, tetanic spasms being produced in the first instance, and peritonæal inflammation being found after death. One ounce introduced into the stomach of a dog excited immediate vomiting, and no farther inconvenience; and two ounces retained by a ligature on the gullet brought on violent efforts to vomit, from which the animal was gradually recovering, when it was killed in twenty-four hours for the sake of observing the appearances. The stomach was found generally inflamed and interspersed with dark, gangrenous-like spots.[464]
I am not acquainted with any case of poisoning with these substances in the human subject. But it is probable that symptoms of pure irritation and inflammation will occur, and that moderate doses may prove fatal.
X. OF POISONING WITH LIME
Lime, the last poison of the present group, is a substance of little interest to the toxicologist, as its activity is not great.
Its physical and chemical properties need not be minutely described. It is soluble, though sparingly, in water; and the solution turns the vegetable blues green, restores the purple of reddened litmus, gives a white precipitate with a stream of carbonic acid gas, and with oxalic acid a very insoluble precipitate, which is not redissolved by an excess of the test.
Its action is purely irritant. Orfila has found that a drachm and a half of unslaked lime, given to a little dog, caused vomiting and slight suffering for a day only, but that three drachms killed the same animal in five days, vomiting, languor, and whining being the only symptoms, and redness of the throat, gullet, and stomach, the only morbid appearances.[465]
Though a feeble poison, it has nevertheless proved fatal in the human subject. Gmelin takes notice of the case of a boy who swallowed some lime in an apple-pie, and died in nine days, affected with thirst, burning in the mouth, burning pain in the belly, and obstinate constipation.[466] A short account of a case of this kind of poisoning is also given by Balthazar Timæus. A young woman, afflicted with pica or depraved appetite, took to the eating of quicklime; and in consequence she was attacked with pain and gnawing in the belly, sore throat, dryness of the mouth, insatiable thirst, difficult breathing and cough; but she recovered.[467] It is well known that quicklime also inflames the skin or even destroys its texture, apparently by withdrawing the water which forms a component part of all soft animal tissues. When thrown into the eyes it causes acute and obstinate ophthalmia, which may end in loss of sight. On this account it will belong, I presume, to the poisons included in the Scottish act against disfiguring or maiming with corrosives.
XI. OF POISONING WITH AMMONIA AND ITS SALTS
The second group of the order of alkaline poisons, including ammonia with its salts, and the sulphuret of potass, have a double action on the system, analogous to that possessed by many metallic poisons. They are powerful irritants; but they produce besides, through the medium of the blood, a disorder of some part of the nervous system; and their remote is sometimes more dangerous than their local action. The nervous affection produced by ammonia and the sulphuret of potass closely resembles tetanus, and therefore depends probably on irritation of the spinal column.
Of the Chemical tests for the Ammoniacal Salts.—Ammonia is when pure a gaseous body; but as commonly seen, it exists in solution in water, which dissolves it in large quantity. The solution has the usual effects of alkalis on vegetable colours, with the difference, however,—that the changes of colour are not permanent under the action of heat. It forms a yellow precipitate, as potass does, with chloride of platinum. It may at once be distinguished from other fluids by its peculiar pungent odour, which is possessed by no other substance except its carbonate.
Various carbonates are known in chemistry, but the only one known in commerce or met with in the shops is the sesqui-carbonate (subcarbonate—smelling salt—volatile salt—hartshorn). It is solid, white, fibrous, and has the same odour as pure ammonia. Its solution differs little in physical properties from the pure liquid ammonia; but, unlike it, is precipitated by the salts of lime.
The hydrochlorate (muriate of ammonia—sal-ammoniac)—is known by its solid, white, crystalline appearance; its ductility; its volatility; and by the effect of caustic potass and nitrate of silver, the former of which disengages an ammoniacal odour, while the latter causes in a solution of the salt a white precipitate, the chloride of silver.
Of the action of the Ammoniacal Salts, and their effects on man.—To determine the action of ammonia on the animal system, Professor Orfila injected sixty grains of the pure solution into the jugular vein of a dog. Immediately the whole legs were spasmodically extended; at times convulsions occurred; and in ten minutes it died. The chest being laid open instantly, coagulated florid blood was seen in the left ventricle, and black fluid blood in the right ventricle of the heart. No unusual appearance was discernible any where else except complete exhaustion of muscular irritability.[468] The experiments of Mr. Blake also show that ammonia introduced in large doses into the veins acts by suddenly extinguishing the irritability of the heart. Small doses first lower arterial pressure from debility of the heart’s action, and then increase it by obstructing the systemic capillaries. When injected into the aorta from the axillary artery, it causes great increase of arterial pressure, owing to the latter cause; and then arrests the heart, while the respiration goes on. Four seconds are sufficient for the ammonia to pass from the jugular vein into the heart, so as to be discovered there by muriatic acid causing white fumes.[469] Half a drachm of a strong solution, introduced by Orfila into the stomach of a dog and secured by a ligature on the gullet, caused at first much agitation. But in five minutes the animal became still and soporose; after five hours it continued able to walk; in twenty hours it was found quite comatose; and death ensued in four hours more. The only morbid appearance was slight mottled redness of the villous coat of the stomach. A third dog, to which two drachms and a half of the common carbonate were given in fine powder, died in twelve minutes. First it vomited; next it became slightly convulsed; and the convulsions gradually increased in strength and frequency till the whole body was agitated by dreadful spasms; then the limbs became rigid, the body and head were bent backwards, and in this state it expired, apparently suffocated in a fit of tetanus.[470]
Several cases of poisoning with ammonia or its carbonate have occurred in the human subject. Plenck has noticed shortly a case which proved fatal in four minutes, and which was caused by a little bottleful of ammonia having been poured into the mouth of a man who had been bitten by a mad-dog.[471] The symptoms are not mentioned, but it is probable, from the rapidity of the poisoning, that a nervous affection must have been induced. More generally, however, the effects are simply irritant; and the seat of the irritation will vary with the mode in which the poison is given. If it is swallowed, the stomach and intestines will suffer; if it is imprudently inhaled in too great quantity, inflammation of the lining membrane of the nostrils and air-passages will ensue. Huxham has related a very interesting example of the former affection, as it occurred in a young man, who had acquired a strange habit of chewing the solid carbonate of the shops. He was seized with great hemorrhage from the nose, gums, and intestines; his teeth dropt out; wasting and hectic fever ensued; and, although he was at length prevailed on to abandon his pernicious habit, he died of extreme exhaustion, after lingering several months.[472] But the most frequent cases of poisoning with ammonia have arisen from its being inhaled, and thus exciting bronchial inflammation. An instructive instance of the kind has been related by M. Nysten. A medical man, liable to epilepsy, was found in a fit by his servant, who ignorantly tried to rouse him by holding assiduously to his nostrils a handkerchief dipped in ammonia. In this way about two drachms appear to have been consumed. On recovering his senses, the gentleman complained of burning pain from the mouth downwards to the stomach, great difficulty in swallowing, difficult breathing, hard cough, and copious expectoration, profuse mucous discharge from the nostrils, and excoriation of the tongue. The bronchitis increased steadily, and carried him off in the course of the third day, without convulsions or any mental disorder having supervened.[473] A case precisely similar is related in the Edinburgh Medical and Surgical Journal. A lad, while convalescent from an attack of fever, was seized with epilepsy, for which his attendant applied ammonia under his nose “with such unwearied, but destructive benevolence, that suffocation had almost resulted. As it was, dyspnœa with severe pain of the throat and breast, immediately succeeded; and death took place forty-eight hours afterwards.”[474] A third instance has been recorded of analogous effects produced by the incautious use of ammonia as an antidote for prussic acid. The patient had all the symptoms of a violent bronchitis, accompanied with redness and scattered ulceration of the mouth and throat; but he recovered in thirteen days.[475] A fourth case, similar to the preceding, has been related by M. Souchard of Batignolles. A druggist, who inhaled while asleep the fumes of ammonia from a broken carboy, awoke in three-quarters of an hour, with the mucous membrane of the mouth and nostrils corroded, and a bloody discharge from the nose. A severe attack of bronchitis followed, during which he could not speak for six days; but being actively treated with antiphlogistic remedies, he recovered.[476]—An extraordinary case has been published by Mr. Paget of death from injecting ammonia into the blood-vessels. A solution weak enough to allow of the nose being held over it was injected into a nævis in a child two years old. An attack of convulsions immediately followed, and in a minute the child expired.[477]
Nysten’s case is the only one in the human subject in which the morbid appearances were ascertained. The nostrils were blocked up with an albuminous membrane. The whole mucous coat of the larynx, trachea, bronchi, and even of some of the bronchial ramifications, was mottled with patches of lymph. The gullet and stomach showed red streaks here and there; and there was a black eschar on the tongue, and another on the lower lip.
Of Poisoning with Hydrochlorate of Ammonia.—The effects of the hydrochlorate of ammonia on animals have been examined by Professor Orfila and Dr. Arnold; but I have not yet met with any instance of its operation as a poison on man. When given to dogs it irritates and inflames the parts it touches, and causes the ordinary symptoms of local irritation. But it also acts remotely. For, first, like arsenic, and other poisons of the third order of irritants, it produces inflammation of the stomach, in whatever way it is applied to the body,—Orfila having found that organ affected when the salt was applied to the subcutaneous cellular tissue;[478] and, secondly, according to the experiments of Arnold, it causes, when swallowed, excessive muscular weakness, slow breathing, violent action of the heart, and tetanic spasms,—effects which cannot arise from mere injury of the stomach. Half a drachm will thus kill a rabbit in eight or ten minutes;[479] and two drachms a small dog in an hour.[480]
XII. OF POISONING WITH THE ALKALINE SULPHURETS
The liver of sulphur, or sulphuret of potass of the pharmacopœias, the last poison of this order to be mentioned, is allied to the ammoniacal salts in action. It is of no great consequence in a toxicological point of view in this country, being put to little use; but several accidents have been caused by it in France, where it is employed for manufacturing artificial sulphureous waters; and farther, its properties should be accurately ascertained, because till lately it was erroneously resorted to as an antidote for some metallic poisons.
Chemical Tests.—It has a grayish, greenish, or yellowish colour when solid; its dust smells of sulphuretted hydrogen, which is also copiously disengaged from it by the mineral acids: and it forms with water a yellow solution of the same odour.—In composite fluids it may be detected by heating it with acetic acid, and passing the disengaged gases through solution of acetate of lead, in which a black precipitate of sulphuret of lead is produced, from the action of sulphuretted-hydrogen.[481]
Action and Symptoms.—Orfila found that a solution of six drachms and a half, secured in the stomach of a dog by a ligature on the gullet, caused death by tetanus in seven minutes, without leaving any morbid appearance in the body; that inferior doses caused death in the same manner, but at a later period, and with symptoms of irritation in the alimentary canal, which also was seen red, black, or even ulcerated after death; that a solution of twenty-two grains injected into the jugular vein killed a dog in two minutes, convulsions having preceded death, and the heart being found paralysed immediately after it; and that a drachm and a half thrust in small fragments under the skin occasioned death in thirteen hours with coma and extensive inflammation of the cellular tissue.[482] There can be no doubt, therefore, that liver of sulphur is a true narcotic acrid poison.—It is absorbed, and may be detected in the blood, liver, kidneys, and urine by Orfila’s process.[483]
Orfila has collected three cases of poisoning in the human subject with this substance;[484] and a fourth has been related by M. Cayol.[485] Of these cases two proved fatal in less than fifteen minutes; and the symptoms were acrid taste, slight vomiting, mortal faintness, and convulsions, with an important chemical sign, the tainting of the air with the odour of sulphuretted-hydrogen. The dose in one case was about three drachms. The two other patients, who recovered, were for some days dangerously ill. The symptoms were burning pain and constriction in the throat, gullet, and stomach; frequent vomiting, at first sulphureous, afterwards sanguinolent; purging, at first sulphureous; sulphureous exhalations from the mouth; pulse at first quick and strong, afterwards feeble, fluttering, and almost imperceptible; in one case sopor; finally severe inflammation of the gullet, stomach and intestines, which abated in three days. One of these patients took four drachms of sulphuret of soda, the other two ounces of sulphuret of potass; but it is probable, that the latter dose was partly decomposed by long keeping.
Morbid Appearances.—The morbid appearances in the two fatal cases were great lividity of the face and extremities, and exhaustion of muscular contractility immediately after death; the stomach was red internally, and lined with sulphur; the duodenum also red; the lungs soft, gorged with black fluid blood, and not crepitant.
Treatment.—The most appropriate treatment consists in the instant administration of any diluent, then of frequent doses of the chloride of soda, and lastly the antiphlogistic mode of subduing inflammation. The chloride of soda or lime decomposes sulphuretted hydrogen, the disengagement of which is the probable cause of death in the quickly fatal cases.[486]